Provider Demographics
NPI:1285868679
Name:SMITH, NIOSHA TEREA (LPN)
Entity type:Individual
Prefix:
First Name:NIOSHA
Middle Name:TEREA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-0804
Mailing Address - Country:US
Mailing Address - Phone:315-877-0204
Mailing Address - Fax:
Practice Address - Street 1:1106 1ST NORTH ST APT 9
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-1661
Practice Address - Country:US
Practice Address - Phone:315-877-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2853611164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse